State Report: Overdose Deaths, Pimps’ Profits + More

This week’s State Report centers on the Senate’s approval of several bills addressing the region’s growing problem of overdose deaths. Additionally, we’ll examine another newly approved measure that looks to seize profits obtained by pimps. Also on the docket is a pair of health related bills – one which addresses prescription drug labels, and another dealing with pharmacist access to electronic prescription databases.

Senate Approves Legislation Addressing Drug Overdoses

On Tuesday, the Senate voted to approve several bills supported by its Health and Human Services Committee to address the recent increase in drug overdose deaths in the region.

“Addressing this epidemic will require approaching it from a number of sides, through drug abuse prevention and treatment efforts and broadening doctors’ ability to prescribe the safest treatments to their patients and to ensure that they are following their treatment plan,” said HHS Chairman Joshua Miller (D-Dist. 28, Cranston, Providence).

The legislation

One of the bills the Senate approved Tuesday addresses health insurance coverage for people with opioid substance use disorder and chronic addiction. Sponsored by Sen. Paul V. Jabour (D-Dist. 5, Providence) the bill (2014-S 2801Aaa) would:

• Strengthens parity in coverage of mental health and substance use disorders, in clear language aligned with federal regulation, and require that both methadone treatment services and medications to treat opioid overdoses be included as covered health benefits.

• Provide patients with substance use disorders with information they need about critical services, when they need it most – when they are being discharged from a hospital. The legislation outlines a process that hospitals can use to make sure that patients with substance use disorders leave with real-time information in hand about community-based facilities and providers that have openings for them. As they leave, these patients would also have a follow-up appointment scheduled for them with licensed professionals who understand substance use disorders.

• Extend the safety net to other health care settings that patients with substance use disorders also consult – places like urgent care settings, freestanding clinics and emergency room diversion facilities. This legislation ensures that these settings also receive information about community and health care resources that can be consulted to support patients with substance use disorders.

• It allows practitioners and pharmacists – the professionals who are in the best position to stop the flow of misused prescription drugs – to designate individuals who can access information from the database. By allowing these professionals to designate others in their office to access this information, prescribers and pharmacists will have about a clearer understanding of their patients’ use of controlled substances. This can help prevent misuse, prevent the misdirection of controlled substances, and alert prescribers and pharmacists about patients who are doctor shopping. Most importantly, it allows these healthcare professionals to help identify those patients who are most at risk of abusing controlled substances, and provide them with the support they need.

• It requires that all practitioners register with the prescription drug monitoring database maintained by the Department of Health, as a condition of their ability to prescribe controlled substances. This requirement would ensure that all prescribers know that this resource is available to them and are better able to integrate the database into their practice.

Additionally the Senate approved a bill (2014-S 2561) sponsored by Sen. Maryellen Goodwin (D-Dist. 1, Providence) which would require the Department of Health to promulgate rules and regulations regarding a system of electronic data transmissions of prescriptions for controlled substances.

The three bills are part of a portfolio the Health and Human Services Committee this year to address the growing problems of drug abuse and overdose. The package also includes:

• 2014-S 2534 – Sponsored by Chairman Miller, this bill would prevent health insurance policies that provide prescription coverage from requiring a beneficiary to use an opioid or another drug with a high risk of dependency before using a non-opioid or a drug with a low risk of dependency, if both could treat the same condition. The bill is meant to prevent prescription drug addiction.

• 2014-S 2524 – Sponsored by Sen. Walter S. Felag Jr. (D-Dist. 10, Warren, Bristol, Tiverton), this bill would allow physicians who prescribe electronically to request a notification about whether the prescription is filled, partially dispensed or not dispensed and returned to the pharmacy’s stock. This bill is aimed at helping doctors determine whether patients, particularly those with drug dependency, are in fact following their treatment plans.

The harsh reality

According to the Centers for Disease Control and Prevention (CDC), almost all prescription drugs involved in overdoses originally come from prescriptions. Very few come from pharmacy theft. However, once they are prescribed and dispensed, prescription drugs are frequently diverted to people using them without prescriptions.

• More than 3 out of 4 people who misuse prescription painkillers use drugs prescribed to someone else.

• Six of the top 10 substances abused by 12th graders are pharmaceuticals

• Forty-nine states, the District of Columbia, and one U.S. territory (Guam) have legislation authorizing the creation and operation of a prescription drug monitoring program to monitor controlled substances as defined by federal and state controlled substances law.

For more legislative news from the past week, check out the slideshow below.

Related Slideshow: RI State Report: More News of the Week - 5/10/14

House OKs bill to seize pimps’ profits

On Thursday, the House of Representatives approved legislation sponsored by Rep. Arthur Corvese to help law enforcement target pimps and others who derive proceeds from pandering or permitting prostitution in the state.

The legislation (2014-H 7620) will now be sent to the Senate, which has already passed similar legislation (2014-S 2820) sponsored by Sen. Frank S. Lombardi (D-Dist. 26, Cranston). Both legislators introduced the legislation on behalf of Attorney General Peter F. Kilmartin.

Under current law, those convicted of prostitution have been subject to forfeiture of any assets received due to their unlawful acts. But those who induce or allow another to provide those services have not been subject to the forfeiture of proceeds that result from the unlawful activity.

The legislation will strike the forfeiture provision from law as it applies to prostitutes, and will add the forfeiture provision to the law dealing with “pimps,” or, as the law describes them, individuals who by any promise or threat, by abuse or by any other device or scheme cause, induce, persuade or encourage a person to become a prostitute.

Senate OKs bill creating a Joint Committee of the Repealer

The Rhode Island Senate has approved legislation sponsored by Sen. Erin P. Lynch (D-Dist. 31, Warwick, Cranston) to establish a new General Assembly Joint Committee of the Repealer, whose job it would be to comb through Rhode Island’s laws and suggest outdated statutes to be repealed.

Over the years, said Senator Lynch, Rhode Island’s General Laws have become littered with statutes that may be hindering economic growth or business development. The new committee, she said, will help to ensure that economic growth is not being held back by outdated laws.

“The new Joint Committee will be a big step forward to ensuring that the state’s laws are adapted to the 21st century, and that no statute from the 1950s is hurting us economically in 2014,” she said.

The Joint Committee of the Repealer would have the formal power to compile a list of statutes, regulations and executive orders that it recommends be repealed based on suggestions received from citizens, agencies and the business community

The committee’s membership would consist of three appointed lawmakers each from the House of Representatives and the Senate (six total), with no more than two members from each House and Senate political party. The Committee would expire on December 31, 2019, unless extended by the General Assembly.

Senator Lynch hopes that with the passage of her bill in the Senate, Rhode Island will adapt the idea to its own economic needs and ensure that businesses are not restrained by unnecessary and out-of-date legislation.

“I think this committee is just what Rhode Island needs,” said Senator Lynch. “If we can clean up our outdated laws and ease the burden on our businesses, we’re definitely on the right track.”

The House of Representatives approved legislation on Wednesday, 2014-H 7574A, sponsored by Rep. William W. O’Brien (D-Dist. 54, North Providence), to expand the categories of individuals authorized to access and use the database and requiring all practitioners to register with the DoH monitoring database as a condition of the initial approval of or renewal of the practitioner’s authority to prescribe controlled substances.

The legislation is the direct result of hearings conducted last year by a special House commission, chaired by Representative O’Brien, that studied establishing an Internet System for Tracking Over-Prescribing (I-STOP) .

“It is imperative that we do whatever we can to help practitioners and pharmacists monitor and ensure the safe use of controlled drugs that are being prescribed,” said Representative O’Brien. “It is important that we do what we can to mitigate the diversion and abuse of these substances. The Department of Health monitoring program is helping to maintain effective controls against diversion of these substances into illegitimate channels, and this legislation will help ensure the greater efficiency and more widespread use of that monitoring database.”

The O’Brien bill, which now goes to the Senate for consideration, would allow other authorized designees of a practitioner or pharmacist to access the database on the practitioner’s or pharmacist’s behalf, provided the designee is employed by the same professional practice or pharmacy, that that practitioner or pharmacist takes reasonable steps to ensure that such a designee is sufficiently competent to use the database and that the ultimate decision as to whether or not to prescribe or dispense a controlled substance remains with the practitioner or pharmacist.

'Country of origin' labeling on pharmaceuticals

Earlier this week, the Senate approved a resolution introduced by Majority Leader Ruggerio, supporting federal legislative and regulatory efforts to increase country-of-origin labeling for pharmaceuticals “to inform consumers of where their drugs are made.”

The Senate resolution, 2014-S 2225, recalls a 2008 incident, when a foreign manufacturer substituted a fake ingredient in a supply of blood thinner medication. The contaminated drug killed 81 people in the United States and sickened hundreds.

“Although that may have been an isolated incident, it nonetheless highlights the safety concerns associated with imported drugs and the need for greater consumer information and protection,” said Majority Leader Ruggerio. “Unless these companies of their own volition stop this potentially dangerous way of doing business, the best we can hope for is full transparency about the drugs that are being put on the market in the U.S.”

The resolution, which would be sent to the members of Rhode Island’s Congressional delegation, supports efforts such as a bill introduced in Congress in 2008 that would require drug labels to include the identity of the country of manufacture of each active and inactive ingredient in the drug.

The U.S. Food and Drug Administration (FDA), in a report issued two years ago, said that more than 80 percent of the active ingredients for drugs sold in the United States are made abroad, often in plants that are rarely inspected. According to data from the U.S. Government Accountability Office, the FDA only inspected 11 percent of the more than 3,700 foreign pharmaceutical manufacturing sites in 2009.

House OKs bill updating, amending vital records laws

In a letter to Rep. K. Joseph Shekarchi (D-Dist. 23, Warwick) in regard to legislation he had introduced, Warwick City Clerk Marie Ahlert wrote to convey a message of support from the Rhode Island City and Town Clerk’s Association:

“We, as clerks, are trying to make an attempt to make sure that everyone in the 39 cities and towns is following the same guidelines when it comes to the issuance of vital records. In this world of stolen identities, we take very precaution that we can to insure the integrity of the vital records we are entrusted to protect in our city/town halls. Without a clear director in our general laws, the issuance of these records has been left up to individual interpretations.”

The legislation, 2014-H 7515, was approved on Tuesday by the House of Representatives and now goes to the Senate for consideration. The bill makes technical amendments to the Vital Records laws, removing an obsolete reference to the local or municipal registry of birth records and updating the statute to reflect that births are now reported electronically.

Among the changes included in the legislation:

It allows a midwife, in addition to a physician, to certify a birth to the Department of Health vital records registry;

It provides that, when a birth occurs in a moving conveyance, the place of birth will be the address in the city or town where the child is first removed from the conveyance;

It gives the Superior Court sole jurisdiction over proceedings relating to certificates of birth rejected by the state registrar of vital records;

It expands the list of individuals who will have access to or be permitted to examine the original or any copy of a birth certificate or birth records. Currently limited to the person whose birth is recorded or his/her issue, parent or guardian, the legislation will make the records available to a spouse, civil union and/or registered domestic partner, grandparent, sibling, attorneys at law, title examiners or members of legally incorporated genealogical societies in the conduct of their officials duties.